The task
Assume that today's date is 22 October 2026. Mrs Kirkwood came into the pharmacy this morning asking to buy naproxen. You have arranged for her to see her GP at 3.30 pm today.
You are a community pharmacist at Station Road Community Pharmacy. Using the information in the case notes, write a letter to Mrs Kirkwood's GP, Dr Kofi Nyberg, to be sent ahead of her same-day appointment. Inform him of her regular use of over-the-counter naproxen, the interaction risk with her current medicines, her current findings and the advice you have given, and request an urgent review. Address the letter to Dr Kofi Nyberg, General Practitioner, Station Road Medical Centre, 42 Station Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Update letter.
Case notes
Patient details
- Name: Mrs Shona Kirkwood
- DOB: 14/03/1955 (71 yrs)
- Regular customer; dispensing and sales records held at pharmacy
- Regular GP: Dr Kofi Nyberg
Social background
- Widowed; lives alone; independent with ADLs
- Keen gardener; kneeling → ↑ knee pain
- Daughter visits fortnightly; pt says daughter 'too busy with her own life to help'
- Complained last month that counter staff were 'slow and unhelpful'
- Reluctant to 'bother' GP; did not mention knee pain at last GP appt
Medical history
- Chronic kidney disease stage 3 (managed by GP)
- Hypertension
- Bilateral knee osteoarthritis (dx 2021), R > L
- Cholecystectomy 2009
- Allergies: nil known
- Regular meds (dispensed here): perindopril 5 mg mane; furosemide 40 mg mane; atorvastatin 20 mg nocte
Pharmacy consultation 22/10/26
- Requested OTC naproxen again; sales record here: 5 x 24-tab packs naproxen sodium 275 mg since 07/26; pt states further packs bought at other pharmacies
- Taking naproxen sodium 275 mg, 2 tabs BD, most days for knee pain for approx. 3/12
- Also uses heat pack on knees in evenings
- Reports ↑ ankle swelling past 2/52; BP (pharmacy monitor) 152/88 mmHg, previous pharmacy readings approx. 135/80
- Denies SOB; reports no noticeable change in urine output
- No other OTC or complementary medicines
- Pt unaware anti-inflammatories can affect kidneys
- Flu vaccine given at pharmacy 03/26
- Asked whether loyalty card discount applies to prescriptions
Assessment
- NSAID + ACE inhibitor + diuretic ('triple whammy') → ↑ risk of acute kidney injury; also risk of hyperkalaemia, fluid retention, ↓ BP control
Advice given
- Advised to stop naproxen immediately; sale declined
- Advised paracetamol per label directions in interim for knee pain
- Advised to avoid all OTC anti-inflammatories (e.g. ibuprofen, some cold & flu products); written info given
- Pt agreed to stop; consented to pharmacist contacting GP
- Safety-net: if ↓ urine output, SOB, confusion or feels unwell before appt → call 000 or attend ED
Plan
- Phoned Station Road Medical Centre → same-day appt with Dr Nyberg 3.30 pm today; letter sent ahead. Request urgent check of renal function & electrolytes (incl. K+), BP, fluid status/ankle swelling
- Suggest GP review OA pain management, incl. non-drug options (e.g. physiotherapy, exercise) and suitable analgesia
- Alert added to pharmacy record to flag any future NSAID requests
Who is reading, and what do they need?
Dr Nyberg manages her CKD and prescribes her regular medicines, but he may not know about the over-the-counter naproxen. He will see her at 3.30 pm today, so he needs the key facts quickly: what she took, the interaction risk, today's findings, advice already given and the checks requested.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Naproxen sodium 275 mg, 2 tabs BD, most days for about 3 months | The GP is unlikely to know about this non-prescribed use, and the dose and duration drive the concern. |
| 5 packs bought here since 07/26; says more bought at other pharmacies | Shows the pharmacy record is only part of her use, so the true amount is uncertain. |
| CKD stage 3, hypertension; perindopril 5 mg and furosemide 40 mg | These are the conditions and medicines that make an NSAID hazardous and the GP needs them tied together. |
| NSAID + ACE inhibitor + diuretic: risk of AKI, hyperkalaemia, fluid retention, reduced BP control | This is the pharmacist's assessment and the reason for urgency; it is a risk, not an established injury. |
| Ankle swelling past 2 weeks; BP 152/88 versus previous about 135/80 | Current findings the GP can compare with his own records when examining her. |
| Denies shortness of breath; no noticeable change in urine output | Relevant negatives that help the GP judge how she presents, without overstating reassurance. |
| Told to stop naproxen, sale declined, paracetamol, avoid OTC anti-inflammatories, safety-net advice | The GP needs to know what she was told, including all four warning signs (reduced urine output, breathlessness, confusion, feeling unwell). |
| Requested renal function, electrolytes including K+, BP, fluid status; review of OA pain management | These are the specific actions the pharmacist is asking of the GP, including non-drug options. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Daughter 'too busy' to help; widowed, lives alone | Family opinion and social detail do not affect the medication concern. |
| Complained counter staff were slow and unhelpful | A service complaint from last month, irrelevant to the clinical request. |
| Flu vaccine at pharmacy 03/26; loyalty card question | Unrelated to this problem and not something the GP must act on. |
| Reluctant to bother GP; did not mention knee pain at last appointment | Looks relevant but is about her attitude; it risks sounding critical and the GP can ask her himself. |
| Atorvastatin, cholecystectomy 2009, gardening, heat pack | Not part of the interaction or the requested checks; compress or omit. |
A paragraph plan for this case
Open with the same-day appointment, the naproxen use and the urgent request. Then give her history and medicines with the interaction risk, then today's findings and negatives. Finish with advice given, the safety-net advice, and the specific checks and pain review requested.
Where candidates slip on this task
- State the interaction as a risk to kidney function, not as acute kidney injury that has occurred, and do not claim naproxen caused the swelling or the higher BP reading.
- Report her naproxen supply accurately: five packs recorded at this pharmacy since 07/26, plus her own statement about other pharmacies. Do not total or extrapolate the amount she has taken.
- If you mention the safety-net advice, give all four listed triggers and both options (call 000 or attend ED), not a shortened version.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Pharmacy letter tasks
- Poor preventer adherence in an asthmatic patient update letter
- School principal asking about a student's adrenaline autoinjector response letter
- Nurse manager asking about crushing medicines for a resident response letter
Your profession's guide: OET Pharmacy. Layout and structure: OET letter format.
Questions about this task
Should the letter explain what a triple whammy is?
Briefly name the combination of an NSAID, ACE inhibitor and diuretic and the risks the notes list. The GP is a clinician, so no lecture is needed. Link the risk to her CKD and current findings.
Do I mention the alert on the pharmacy record?
It is optional. It is a pharmacy action, not something the GP must act on. If space is tight, prioritise findings, advice given and the checks requested.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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